Bright Red Blood in Stool: Causes and Recommendations

Rectal bleeding

Hello Doctor, I know I have gallstones, but when I went out to eat with friends, I had some greasy Hong Kong-style food, like pineapple buns.
That night, I experienced pain in my lower back, and I noticed bright red blood in my stool, which dissolved in water, but it wasn't a lot.
The stool itself appeared normal.
The next day, I had blood in my stool again, still bright red but more than before, and it also dissolved in water.
The stool was still in a normal state, with a light brown color and not black.
There was no pain during bowel movements, and they were smooth and quick.
I looked online and think it might be internal hemorrhoids, but I'm a bit worried.
My job involves sitting for long periods, so I feel the likelihood of internal hemorrhoids is high.
I would like to observe for another week.
Do you have any suggestions, Doctor?

Zhang, 20~29 year old female. Ask Date: 2020/07/12

Dr. Chen Shidian reply Gastroenterology and Hepatology

Further observation is needed to determine if bleeding persists, or a colonoscopy should be scheduled for examination of the sigmoid colon.

Reply Date: 2020/07/12

More Info

Bright red blood in the stool can be alarming, and it’s understandable to feel concerned, especially given your history of gallstones and your recent dietary choices. The presence of bright red blood typically indicates that the bleeding is occurring in the lower gastrointestinal tract, such as the rectum or anus, rather than higher up in the digestive system. This is an important distinction because it can help narrow down potential causes.

Given your symptoms, there are several possible explanations for the bright red blood in your stool:
1. Hemorrhoids (Piles): This is one of the most common causes of bright red blood in the stool, especially in individuals who sit for prolonged periods, as you mentioned. Hemorrhoids can be internal or external and may cause bleeding during bowel movements, often accompanied by itching or discomfort.

2. Anal Fissures: These are small tears in the lining of the anus, often caused by passing hard stools. They can lead to sharp pain during bowel movements and may also result in bright red blood.

3. Diverticular Disease: Diverticulosis, which involves the formation of small pouches in the colon wall, can sometimes lead to diverticulitis, where these pouches become inflamed or infected, potentially causing bleeding.

4. Colorectal Polyps or Cancer: While less common, especially in younger individuals, polyps or colorectal cancer can also present with bright red blood in the stool. This is more likely if there are additional symptoms such as changes in bowel habits, unexplained weight loss, or abdominal pain.

5. Gastrointestinal Infections: Certain infections can cause inflammation and bleeding in the gastrointestinal tract, leading to bright red blood in the stool.

Given that you have experienced this symptom more than once and considering your lifestyle factors (such as prolonged sitting), it is wise to monitor your symptoms closely. Here are some recommendations:
- Dietary Adjustments: Since you mentioned consuming a rich, oily meal, consider moderating your intake of high-fat foods, especially if you have gallstones. A diet high in fiber can help prevent constipation and reduce the risk of hemorrhoids and fissures.

- Hydration: Ensure you are drinking plenty of water, as this can help maintain stool consistency and prevent straining during bowel movements.

- Physical Activity: Incorporate regular physical activity into your routine, as this can improve bowel function and reduce the risk of hemorrhoids.

- Monitor Symptoms: Keep track of the frequency and amount of blood in your stool, as well as any accompanying symptoms such as pain, changes in bowel habits, or weight loss.

- Consult a Healthcare Provider: If the bleeding persists, increases in volume, or is accompanied by other concerning symptoms, it is crucial to seek medical attention. A healthcare provider may recommend a physical examination, possibly including a digital rectal exam, and further diagnostic tests such as a colonoscopy to determine the exact cause of the bleeding.

In summary, while hemorrhoids or anal fissures are likely culprits given your symptoms and lifestyle, it is essential to remain vigilant and consult a healthcare professional if your symptoms do not improve or worsen. Early intervention can help address any underlying issues effectively.

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